The 40 Treatments & Actions and 66 Hospital Readiness Requirements of EECC

The 40 Clinical Processes in Essential Emergency and Critical Care

The clinical processes are the treatments and actions in EECC, consisting of the identification of critical illness, the immediate and ongoing essential care of critical illness and the general processes of care.

You can also download all 40 Treatments & Actions.

The Identification of Critical Illness

Critical illness is identified as soon as possible so timely care can be provided.

The hospital uses vital signs-based triage to identify critical illness

  • 1.1.1 Pulse rate

    1.1.2 Blood pressure

    1.1.3 Respiratory rate

    1.1.4 Oxygen saturation (SpO2)

    1.1.5 Temperature

    1.1.6 Level of consciousness (eg. “AVPU”, “ACVPU” or Glasgow Coma Scale)

    1.1.7 Presence of abnormal airway sounds heard from the bedside (eg. snoring, gurgling, stridor) 

    1.1.8 The overall condition of the patient (health worker’s concern that the patient is critically ill)

  • Item1.2.1 When a patient arrives at hospital seeking acute care

    1.2.2 For hospital in-patients, at least every 24 hours, unless otherwise prescribed, with increased frequency for patients who are at risk of becoming critically ill or who are critically ill, and then less frequently again when patients are stabilising

    1.2.3 When a health worker, or the patient or guardian, is concerned that a patient may be critically ill

    1.2.4 During and after surgery or anaesthesia

    1.2.5 During and after transport/transfer of a patient who is critically ill or at risk of becoming critically ill

    1.2.6 Following a treatment or action (re-evaluation) description

Care of Critical Illness

Essential care of critical illness is initiated as soon as critical illness is identified and involves these clinical processes when appropriate:

  • 2. Placing the patient in the recovery position (lateral position)

    3. Age-appropriate airway positioning (eg. chin lift or jaw thrust in adults, neutral position in young children)

    4. Removal of any visible foreign body from the mouth or use of age-appropriate chest thrusts/ abdominal thrusts/ back blows in choking

    5. Suction for secretions that are obstructing the airway

    6. Insertion of an oro-pharyngeal (Guedel) airway

  • 7. Optimizing the patient’s position (eg. sitting-up or prone)

    8. Oxygen therapy using nasal prongs, facemask, or mask with a reservoir bag (non re-breathing mask)

    9. Bag-valve-mask ventilation in threatened or manifest respiratory arrest

  • 10. Optimizing the patient position (eg. lying flat, head-down, raised-legs, lateral tilt in pregnancy)

    11. Compression and elevation to stop bleeding

    12. Appropriate bolus of intravenous fluid

    13. Oral rehydration solution or other appropriate oral fluids for dehydration without shock

    14. Intramuscular adrenaline for anaphylaxis

    15. Uterine massage and/or oxytocin when indicated

  • 16. Treating an unconscious patient as having a threatened airway (eg. recovery position etc)

    17. Dextrose (iv or buccal) in unconsciousness or seizures unless bedside blood glucose testing rules out hypoglycaemia or there is a clear alternative cause

    18. Protecting patients with a seizure from harm

    19. Quick-acting anti-seizure medication (eg. intravenous/rectal diazepam, or magnesium sulphate in pregnancy/post-partum)

    20. Cooling in severe hyperthermia with a reduced level of consciousness

  • 21. Insertion of an intravenous cannula when critical illness is identified

    22. Insertion of an intraosseous cannula, if indicated, if an intravenous cannula is not possible

    23. Stabilizing the cervical spine in possible cervical spine injury

    24. Appropriate antibiotics for sepsis

    25. Treatment of pain and anxiety (eg. with needs-based psychological support, medication)

    26. Keeping the patient warm using blankets and other means (including skin-to-skin care for babies)

    27. Feeding (including breastfeeding for babies), naso-gastric feeding and dextrose for nutrition and to avoid hypoglycaemia

    28. Prevention of delirium (eg. sleep hygiene, provision of the patient’s glasses or hearing aid)

    29. Regular turning of immobilised patients

    30. Mobilising the patient as early as possible

General Processes

  • 31. Assistance from additional or senior staff is sought when a critically ill patient is identified

    32. Essential Emergency and Critical Care (EECC) is respectful and patient-centred 

    33. EECC is provided without considering the patient’s ability to pay

    34. Critically ill patients are cared-for in locations that facilitate observation and care (eg. designated beds, a bay or a unit for critically ill patients)

    35. Infection, Prevention and Control (IPC) measures are used including hand hygiene and separation of patients with a suspected or confirmed contagious disease from those without

    36. Communication is clear, including:

    • Within the care team when a patient is identified as critically ill (eg. verbal communication, at staff handovers, visible colour-coding)

    • Within the care team about the planned EECC (eg. continue oxygen therapy, give intravenous fluids)

    • Documentation in the patient notes about the vital signs, when critical illness has been identified and the treatments and actions conducted 

    • Effective and respectful communication with the patient and family

    37. If there is poor response to treatment, or if the patient deteriorates, other indicated EECC clinical processes are used 

    38. Clinical processes are discontinued that are no longer indicated (eg. if a patient improves or if they are deemed to no longer be in the patient’s best interest)

    39. It is recognised when EECC alone is not sufficient to manage the critical illness

    40. EECC is integrated with care that is outside the scope of EECC (eg. the need for prompt investigations, definitive treatment of underlying conditions including following disease-specific best-practice guidelines, end-of-life care, referral)

Extended identification of critical illness

    • Presence of respiratory distress (eg unable to complete sentences; accessory muscle use; chest recessions; grunting or head nodding)

    • Cyanosis

    • Capillary refill time

    • Cold or warm extremities

    • Presence of severe dehydration (eg decreased skin turgor; dry mucous membranes; sunken fontanelle)

    • Confused, agitated or disoriented mental state

    • Presence of prostration or lethargy

    • Presence of a generalized seizure

    • Inability to stand or walk without help

    • Inability to breastfeed or feed in a young child

    • Presence of severe acute malnutrition

Hospital Readiness Requirements

Below are the resources required for hospitals to be ready to provide Essential Emergency and Critical Care (EECC). This includes the identification of critical illness and the essential care of critical illness.

You can also download all 66 Hospital Readiness Requirements.

The Identification of Critical Illness

  • 1.1.1 Clock with second hand

    1.1.2 Pulse oximeter & probe

    1.1.3 Blood pressure measuring equipment (eg. sphygmomanometer with a stethoscope) 

    1.1.4 Blood pressure cuffs of different paediatric and adult sizes

    1.1.5 Light source (lamp or flashlight) 

    1.1.6 Thermometer

  • 1.2.1 Soap or hand disinfectant 

    1.2.2 Examination gloves

  • None

  • 1.4.1 Health workers with the ability to identify critical illness 24h/day

  • 1.5.1 The health workers are trained in the identification of critical illness

  • 1.6.1 Routines for the identification of critical illness

  • 1.7.1 Guidelines for the identification of critical illness

  • 1.8.1 Designated triage area (area for the identification of critical illness) in the Out-Patient Department or Emergency Unit (area of the hospital where patients arrive)

    1.8.2 Running water

The Care of Critical Illness

  • 2.1.1 Suction machine (electric or manual) 

    2.1.3 Oxygen supply 24h/day (cylinder, concentrator (with electricity supply) or piped oxygen) 

    2.1.4 Flow meter (if using cylinder or piped oxygen)

    2.1.5 Leak-free connectors from oxygen source to tubing 

    2.1.6 Bag Valve Mask (resuscitator) – neonatal, paediatric and adult sizes

    2.1.7 Sharps disposal container

    2.1.8 External heat source

  • 2.2.1 Suction catheters of paediatric and adult sizes

    2.2.2 Guedel airways of paediatric and adult sizes 

    2.2.3 Pillows

    2.2.4 Oxygen tubing

    2.2.5 Oxygen nasal prongs

    2.2.6 Oxygen face masks of paediatric and adult sizes

    2.2.7 Oxygen face masks with reservoir bags of paediatric and adult sizes

    2.2.8 Masks for Bag Valve Mask (resuscitator) – neonatal, paediatric and adult sizes 

    2.2.9 Compression bandages

    2.2.10 Plasters or tape

    2.2.11 Gauze  

    2.2.12 Intravenous cannulas of paediatric and adult sizes 

    2.2.13 Intravenous giving sets 

    2.2.14 Skin disinfectant for cannulation  

    2.2.15 Syringes  

    2.2.16 Nutrition 

    2.2.17 Nasogastric tubes

    2.2.18 Lubricant for nasogastric tube insertion

    2.2.19 Intramuscular needles

    2.2.20 Intraosseous cannulas of different sizes

    2.2.21 Blankets 

    2.2.22 Facemasks for Infection Prevention and Control 

    2.2.23 Aprons or gowns

    2.2.24 Charts/notes for documentation  

    2.2.25 Pens

  • 2.3.1 Oral rehydration solution 

    2.3.2 Intravenous crystalloid fluids (eg. normal saline or Ringer’s Lactate)

    2.3.3 Intravenous dextrose fluid (eg. 5%, 10% or 50%)

    2.3.4 Oxytocin

    2.3.5 Adrenaline 

    2.3.6 Appropriate antibiotics

    2.3.7 Diazepam

    2.3.8 Magnesium sulphate

    2.3.9 Paracetamol

    2.3.10 Local anaesthetic (eg. 2% lignocaine) (eg. for intraosseous cannulation)

  • 2.4.1 Health workers with the ability to care for critically ill patients 24hrs/day

    2.4.2 Senior health worker who can be called to assist with the care of critically ill patients 24hrs/day

  • 2.5.1 The health workers are trained in the care of critically ill patients

  • 2.6.1 Routines for managing critically ill patients

    2.6.2 Routine for the provision of EECC without taking into account patients’ ability to pay

    2.6.3 Routines for who and how to call to seek senior help 24hrs/day, 7 days/week

    2.6.4 Routines for integrating EECC with other care including the definitive care of the underlying condition (eg. use of condition-specific guidelines)

  • 1.7.1 Guidelines for the essential care of critical illness

  • 2.8.1 Designated space for the care of critically ill patients (eg. a bay, ward, high dependency unit)

    2.8.2 Areas for separating and managing patients with a suspected or confirmed contagious disease from those without

The 40 Actions & Treatments